Leigh Ann Holterman

A Prospective Evaluation of the Landing Error Scoring System (LESS) as a Screening Tool for Anterior Cruciate Ligament Injury Risk

Background: Anterior cruciate ligament (ACL) injuries are immediately disabling, costly, take a significant amount of time to rehabilitate, and are associated with an increased risk of developing posttraumatic osteoarthritis of the knee. Specific multiplanar movement patterns of the lower extremity, such as those associated with the drop vertical jump (DVJ) test, have been shown to be associated with an increased risk of suffering noncontact ACL injuries. The Landing Error Scoring System (LESS) has been developed as a tool that can be applied to identify individuals who display at-risk movement patterns during the DVJ. Hypothesis: An increase in LESS score is associated with an increased risk of noncontact ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Over a 3-year interval, 5047 high school and college participants performed preseason DVJ tests that were recorded using commercial video cameras. All participants were followed for ACL injury during their sports season, and video data from injured participants and matched controls were then assessed with the LESS. Conditional logistic regression analysis was used to examine the association between LESS score and ACL injury risk in all participants as well as subgroups of female, male, high school, and college participants. Results: There was no relationship between the risk of suffering ACL injury and LESS score whether measured as a continuous or a categorical variable. This was the case for all participants combined (odds ratio, 1.04 per unit increase in LESS score; 95% confidence interval, 0.80-1.35) as well as within each subgroup (odds ratio range, 0.99-1.14). Conclusion: The LESS did not predict ACL injury in our cohort of high school and college athletes.

Application of a Clinic-Based Algorithm as a Tool to Identify Female Athletes at Risk for Anterior Cruciate Ligament Injury: A Prospective Cohort Study With a Nested, Matched Case-Control Analysis

Background: When landing from a jump, the production of increased intersegmental knee abduction moments and coupled valgus motions has been associated with an increased risk of suffering a noncontact anterior cruciate ligament (ACL) injury in one study. This research has led to the development of a clinic-based algorithm that utilizes measures of knee valgus motion, knee flexion range of motion, body mass, tibial length, and quadriceps-to-hamstring strength ratio data to predict the probability of a high knee abduction moment (pKAM) when landing from a jump in female athletes. The ability of this algorithm to identify athletes at increased risk of suffering ACL injury has not been assessed. Hypothesis: The pKAM is associated with ACL injury in female athletes. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on secondary analysis of data obtained from a previous investigation that focused on the use of the drop vertical jump (DVJ) test to assess the risk of ACL injury in female athletes. The DVJ screenings were performed on 1855 female high school and college athletes over 3 years. Knee valgus motion, knee flexion range of motion, and tibial length were measured from videos of the DVJ obtained during preseason screenings. Mass was measured using a physician’s scale, and quadriceps-to-hamstring strength ratio was included using a surrogate value. These data were entered into the clinic-based algorithm that determined the pKAM. The association of pKAM with ACL injury was assessed using conditional logistic regression. Results: A total of 20 athletes sustained ACL injury and were matched with 45 uninjured control athletes who were recruited from the same teams. There was no relationship between the risk of suffering ACL injury and pKAM, as determined by the clinic-based algorithm. Conclusion: The pKAM was not associated with noncontact ACL injury in our group of injured athletes and matched controls.

Geometric profile of the tibial plateau cartilage surface is associated with the risk of non-contact anterior cruciate ligament injury.

The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non‐contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case–control analysis. Seventy‐eight subjects who suffered a non‐contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL‐injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL‐injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL‐injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial (p < 0.006) and lateral (p < 0.001) compartments. ACL‐injured subjects tended to demonstrate a posterior–inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior–superior directed orientation.

Relational victimization and depressive symptoms: The role of autonomic nervous system reactivity in emerging adults

The goal of the current study was to investigate the association between relational victimization, defined as being the target of aggressive acts that damage relationships (e.g., gossip, social exclusion) and depressive symptoms during the relatively understudied developmental period of emerging adulthood. In addition, as individual differences in stress reactivity may influence the outcomes associated with victimization by peers, the moderating roles of sympathetic nervous system (SNS; as measured by skin conductance reactivity) and parasympathetic nervous system (PNS; as measured by respiratory sinus arrhythmia) reactivity to social and non-social stressors were examined. Findings indicated that relational victimization was positively related to depressive symptoms in individuals demonstrating coactivation (i.e., high SNS and PNS reactivity) and coinhibition (blunted SNS and PNS reactivity) to both social and non-social stressor tasks. These patterns may reflect a breakdown of regulation in the bodys physiological response to stress, thus increasing risk for depressive symptoms in the context of peer stress. Findings highlight potential areas for future interventions.